What should you do if someone tells you they are thinking about suicide?

If someone tells you they are thinking about suicide, you should take their distress
seriously, listen nonjudgmentally, and help them get to a professional for evaluation
and treatment. People consider suicide when they are hopeless and unable to see alternative
solutions to problems. Suicidal behavior is most often related to a mental disorder
(depression) or to alcohol or other substance abuse. Suicidal behavior is also more
likely to occur when people experience stressful events (major losses, incarceration).
If someone is in imminent danger of harming himself or herself, do not leave the person
alone. You may need to take emergency steps to get help, such as calling 911. When
someone is in a suicidal crisis, it is important to limit access to firearms or other
lethal means of committing suicide.

What are the most common methods of suicide?

Firearms are the most commonly used method of suicide for men and women, accounting
for 60 percent of all suicides. Nearly 80 percent of all firearm suicides are committed
by white males. The second most common method for men is hanging; for women, the second
most common method is self-poisoning including drug overdose. The presence of a firearm
in the home has been found to be an independent, additional risk factor for suicide.
Thus, when a family member or health care provider is faced with an individual at
risk for suicide, they should make sure that firearms are removed from the home.

Why do men commit suicide more often than women do?

More than four times as many men as women die by suicide; but women attempt suicide
more often during their lives than do men, and women report higher rates of depression.
Men and women use different suicide methods. Women in all countries are more likely
to ingest poisons than men. In countries where the poisons are highly lethal and/or
where treatment resources scarce, rescue is rare and hence female suicides outnumber
males.

Who is at highest risk for suicide in the U.S.?

There is a common perception that suicide rates are highest among the young. However,
it is the elderly, particularly older white males that have the highest rates. And
among white males 65 and older, risk goes up with age. White men 85 and older have
a suicide rate that is six times that of the overall national rate. Some older persons
are less likely to survive attempts because they are less likely to recuperate. Over
70 percent of older suicide victims have been to their primary care physician within
the month of their death, many did not tell their doctors they were depressed nor
did the doctor detect it. This has led to research efforts to determine how to best
improve physicians? abilities to detect and treat depression in older adults.

Are gay and lesbian youth at high risk for suicide?

With regard to completed suicide, there are no national statistics for suicide rates
among gay, lesbian or bisexual (GLB) persons. Sexual orientation is not a question
on the death certificate, and to determine whether rates are higher for GLB persons,
we would need to know the proportion of the U.S. population that considers themselves
gay, lesbian or bisexual. Sexual orientation is a personal characteristic that people
can, and often do choose to hide, so that in psychological autopsy studies of suicide
victims where risk factors are examined, it is difficult to know for certain the victim?s
sexual orientation. This is particularly a problem when considering GLB youth who
may be less certain of their sexual orientation and less open. In the few studies
examining risk factors for suicide where sexual orientation was assessed, the risk
for gay or lesbian persons did not appear any greater than among heterosexuals, once
mental and substance abuse disorders were taken into account.

With regard to suicide attempts, several state and national studies have reported
that high school students who report to be homosexually and bisexually active have
higher rates of suicide thoughts and attempts in the past year compared to youth with
heterosexual experience. Experts have not been in complete agreement about the best
way to measure reports of adolescent suicide attempts, or sexual orientation, so the
data are subject to question. But they do agree that efforts should focus on how to
help GLB youth grow up to be healthy and successful despite the obstacles that they
face. Because school based suicide awareness programs have not proven effective for
youth in general, and in some cases have caused increased distress in vulnerable youth,
they are not likely to be helpful for GLB youth either. Because young people should
not be exposed to programs that do not work, and certainly not to programs that increase
risk, more research is needed to develop safe and effective programs.

Are African American youth at great risk for suicide?

Historically, African Americans have had much lower rates of suicides compared to
white Americans. However, beginning in the 1980s, the rates for African American male
youth began to rise at a much faster rate than their white counterparts. The most
recent trends suggest a decrease in suicide across all gender and racial groups, but
health policy experts remain concerned about the increase in suicide by firearms for
all young males. Whether African American male youth are more likely to engage in
?victim-precipitated homicide? by deliberately getting in the line of fire of either
gang or law enforcement activity, remains an important research question, as such
deaths are not typically classified as suicides.

Is suicide related to impulsiveness?

Impulsiveness is the tendency to act without thinking through a plan or its consequences.
It is a symptom of a number of mental disorders, and therefore, it has been linked
to suicidal behavior usually through its association with mental disorders and/or
substance abuse. The mental disorders with impulsiveness most linked to suicide include
borderline personality disorder among young females, conduct disorder among young
males and antisocial behavior in adult males, and alcohol and substance abuse among
young and middle-aged males. Impulsiveness appears to have a lesser role in older
adult suicides. Attention deficit hyperactivity disorder that has impulsiveness as
a characteristic is not a strong risk factor for suicide by itself. Impulsiveness
has been linked with aggressive and violent behaviors including homicide and suicide.
However, impulsiveness without aggression or violence present has also been found
to contribute to risk for suicide.

Is there such a thing as "rational" suicide?

Some right-to-die advocacy groups promote the idea that suicide, including assisted
suicide, can be a rational decision. Others have argued that suicide is never a rational
decision and that it is the result of depression, anxiety, and fear of being dependent
or a burden. Surveys of terminally ill persons indicate that very few consider taking
their own life, and when they do, it is in the context of depression. Attitude surveys
suggest that assisted suicide is more acceptable by the public and health providers
for the old who are ill or disabled, compared to the young who are ill or disabled.
At this time, there is limited research on the frequency with which persons with terminal
illness have depression and suicidal ideation, whether they would consider assisted
suicide, the characteristics of such persons, and the context of their depression
and suicidal thoughts, such as family stress, or availability of palliative care.
Neither is it yet clear what effect other factors such as the availability of social
support, access to care, and pain relief may have on end-of-life preferences. This
public debate will be better informed after such research is conducted.

What biological factors increase risk for suicide?

Researchers believe that both depression and suicidal behavior can be linked to decreased
serotonin in the brain. Low levels of a serotonin metabolite, 5-HIAA, have been detected
in cerebral spinal fluid in persons who have attempted suicide, as well as by postmortem
studies examining certain brain regions of suicide victims. One of the goals of understanding
the biology of suicidal behavior is to improve treatments. Scientists have learned
that serotonin receptors in the brain increase their activity in persons with major
depression and suicidality, which explains why medications that desensitize or down-regulate
these receptors (such as the serotonin reuptake inhibitors, or SSRIs) have been found
effective in treating depression. Currently, studies are underway to examine to what
extent medications like SSRIs can reduce suicidal behavior.

Can the risk for suicide be inherited?

There is growing evidence that familial and genetic factors contribute to the risk
for suicidal behavior. Major psychiatric illnesses, including bipolar disorder, major
depression, schizophrenia, alcoholism and substance abuse, and certain personality
disorders, which run in families, increase the risk for suicidal behavior. This does
not mean that suicidal behavior is inevitable for individuals with this family history;
it simply means that such persons may be more vulnerable and should take steps to
reduce their risk, such as getting evaluation and treatment at the first sign of mental
illness.

Does depression increase the risk for suicide?

Although the majority of people who have depression do not die by suicide, having
major depression does increase suicide risk compared to people without depression.
The risk of death by suicide may, in part, be related to the severity of the depression.
New data on depression that has followed people over long periods of time suggests
that about 2 percent of those people ever treated for depression in an outpatient
setting will die by suicide. Among those ever treated for depression in an inpatient
hospital setting, the rate of death by suicide is twice as high (4 percent). Those
treated for depression as inpatients following suicide ideation or suicide attempts
are about three times as likely to die by suicide (6 percent) as those who were only
treated as outpatients. There are also dramatic gender differences in lifetime risk
of suicide in depression. Whereas about 7 percent of men with a lifetime history of
depression will die by suicide, only 1 percent of women with a lifetime history of
depression will die by suicide.

Another way about thinking of suicide risk and depression is to examine the lives
of people who have died by suicide and see what proportion of them were depressed.
From that perspective, it is estimated that about 60 percent of people who commit
suicide have had a mood disorder (e.g., major depression, bipolar disorder, dysthymia).
Younger persons who kill themselves often have a substance abuse disorder in addition
to being depressed.

Does alcohol and other drug abuse increase the risk for suicide?

A number of recent national surveys have helped shed light on the relationship between
alcohol and other drug use and suicidal behavior. A review of minimum-age drinking
laws and suicides among youths age 18 to 20 found that lower minimum-age drinking
laws was associated with higher youth suicide rates. In a large study following adults
who drink alcohol, suicide ideation was reported among persons with depression. In
another survey, persons who reported that they had made a suicide attempt during their
lifetime were more likely to have had a depressive disorder, and many also had an
alcohol and/or substance abuse disorder. In a study of all non-traffic injury deaths
associated with alcohol intoxication, over 20 percent were suicides.

In studies that examine risk factors among people who have completed suicide, substance
use and abuse occurs more frequently among youth and adults, compared to older persons.
For particular groups at risk, such as American Indians and Alaskan Natives, depression
and alcohol use and abuse are the most common risk factors for completed suicide.
Alcohol and substance abuse problems contribute to suicidal behavior in several ways.
Persons who are dependent on substances often have a number of other risk factors
for suicide. In addition to being depressed, they are also likely to have social and
financial problems. Substance use and abuse can be common among persons prone to be
impulsive, and among persons who engage in many types of high risk behaviors that
result in self-harm. Fortunately, there are a number of effective prevention efforts
that reduce risk for substance abuse in youth, and there are effective treatments
for alcohol and substance use problems. Researchers are currently testing treatments
specifically for persons with substance abuse problems who are also suicidal, or have
attempted suicide in the past.

What does "suicide contagion" mean, and what can be done to prevent it?

Suicide contagion is the exposure to suicide or suicidal behaviors within one's family,
one's peer group, or through media reports of suicide and can result in an increase
in suicide and suicidal behaviors. Direct and indirect exposure to suicidal behavior
has been shown to precede an increase in suicidal behavior in persons at risk for
suicide, especially in adolescents and young adults.

The risk for suicide contagion as a result of media reporting can be minimized by
factual and concise media reports of suicide. Reports of suicide should not be repetitive,
as prolonged exposure can increase the likelihood of suicide contagion. Suicide is
the result of many complex factors; therefore media coverage should not report oversimplified
explanations such as recent negative life events or acute stressors. Reports should
not divulge detailed descriptions of the method used to avoid possible duplication.
Reports should not glorify the victim and should not imply that suicide was effective
in achieving a personal goal such as gaining media attention. In addition, information
such as hotlines or emergency contacts should be provided for those at risk for suicide.

Following exposure to suicide or suicidal behaviors within one's family or peer group,
suicide risk can be minimized by having family members, friends, peers, and colleagues
of the victim evaluated by a mental health professional. Persons deemed at risk for
suicide should then be referred for additional mental health services.

Is it possible to predict suicide?

At the current time there is no definitive measure to predict suicide or suicidal
behavior. Researchers have identified factors that place individuals at higher risk
for suicide, but very few persons with these risk factors will actually commit suicide.
Risk factors include mental illness, substance abuse, previous suicide attempts, family
history of suicide, history of being sexually abused, and impulsive or aggressive
tendencies. Suicide is a relatively rare event and it is therefore difficult to predict
which persons with these risk factors will ultimately commit suicide.

If you or someone you know are in crisis, please call either the National Suicide Prevention Lifeline at 1-800-273-TALK or call 911.

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